Archive | September, 2011

Before September 11 brought a country together, Americans were forced to first privately accept the day’s events as a coordinated terrorist attack.

For Frank Silecchia (pictured with former New York Mayor Rudolph Giuliani), that moment occurred on the New Jersey Turnpike.

“I just looked up and saw it happening,” he says in an interview with AOL Jobs. ” ‘They don’t know what they’ve done,’ I kept thinking.”

Silecchia was a construction worker working on site in New Jersey’s Bergen County with the Local 731. He quickly let the rest of the workers he was overseeing go home.

On the following day, Silecchia reported for duty at Ground Zero as a first responder and recovery worker. By Sept. 13, the burly 6-foot-2-inch goateed construction worker had recovered three bodies from Building 6. That same morning, he came across remnants of steel beams, the shape of which impressed him.

“I saw it in the twilight of the morning,” he says. “It was in the shape of a cross, and it gave uplift to the rescue effort.” The so-called Ground Zero cross became one of the lasting symbols of the cleanup effort.

Working daily on the site until the following June 30, Silecchia speaks of the toll that the recovery took on him. “It was like a war campaign,” says the Navy veteran of the Vietnam War. “I felt myself gradually diminish. Four years later, I was working at the JetBlue hangar at JFK, I couldn’t hold the concrete. Then working for Metro-North, I couldn’t walk three blocks.”

At age 49, Silecchia retired on disability, something that he says would never have happened were it not for his recovery work at Ground Zero.

Understanding The Effects Of Working At Ground Zero

He is not alone. There is no official tally of the rescue and recovery workers at Ground Zero, nor is there an official registry of how they were affected by the experience. But estimates of the total number of cleanup participants hover around 60,000 to 80,000. They represented every state in the union. They included police officers and firefighters, but also construction workers and carpenters less accustomed to confronting human tragedy. Their official cleanup was declared complete on May 30, 2002. Clinicians are only now, 10 years later, beginning to understand the effects of working as a rescue and recovery worker at Ground Zero.

“It was impossible to get a true control group,” says the study’s lead author, Dr. Juan Wisnivesky, the vice chair for research department of medicine at Mount Sinai, in an interview with AOL Jobs. “But these rates are certainly high as compared to the general population.” Among the most glaring findings, Wisnivesky says, was the high incidence of asthma for the responders. Nine years after the rescue mission, the percentage of rescue workers diagnosed with asthma stood at 27.6 percent, or roughly three times higher than the normal rate.

“The responders said if they wore respirators or masks, they couldn’t do their jobs,” he says. “So they didn’t.”

Exposure To 2,500 Toxins

Asthma, however, is a mere sampling of the health problems that have been caused by the Ground Zero cleanup. Exposure to the roughly 2,500 toxins, including asbestos and mercury, at the disaster site led to at least 1,000 deaths, reports estimate. The suffering has not gone unnoticed, but the struggle to protect, care for and compensate the rescue workers has been shrouded in controversy since the attacks. Most famously, George W. Bush’s first director of the Environmental Protection Agency, Christine Whitman, said on Sept. 18 that the air in lower Manhattan was “safe to breathe.” In congressional hearings held in 2007, she went on record to deny misleading the public about air and water quality at Ground Zero.

“All the politicians let us down,” says John Feal (pictured fist-bumping Sen. Charles Schumer, D-N.Y.), a construction worker who was a rescue worker for five days before an 8,000-lb. steel beam crushed his left foot. “I think a circus monkey could outpolitic all of them. None of them had the Abe Lincolns to do what was right.”

Motivated by his experience of having to obtain his health benefits on his own, Feal founded the FealGood Foundation in 2005 to help other rescue workers. He takes no paycheck, and often secures money for the struggling first responders. He says that he helps a new rescue worker enroll in a benefits program every three days.

“No one should have to go through getting their benefits alone,” he says in an interview with AOL Jobs. “I am a reaction to a lack of reaction.”

Feal was among the leading advocates of the James Zadroga 9/11 Health and Compensation Act, which formalized a program to extend health benefits for those directly impacted by the attacks. Among those eligible are residents who breathed in the toxins. The chief aspect of the Zadroga program established a process for medical screenings and regular treatment for the first responders. Sponsored by New York Democratic Rep. Carolyn Maloney, the Zadroga Bill was initally held up by Republican filibuster, as the GOP looked to push back against President Obama’s bid to end tax cuts for Americans making over $250,000 a year. After a high profile campaign backed by Jon Stewart, among others, the Zadroga Bill was passed by Congress on Dec. 22, 2010, and signed into law by President Barack Obama on Jan. 2, 2011.

For Feal, the devotion to the rescue workers has been cathartic.

“I might have lost half a foot, but I gained an extra heart,” he says.

He was under the knife for successive surgeries on his foot until 2006.

“I had a John Wayne mentality,” he says. “I thought I was invincible. I just thought when I got hurt, I’d be back soon. It made me realize I could be defeated. For me, I got my post-traumatic-shock hand-delivered because of what happened.”

Coping Physically And Mentally

Feal says that a year of therapy helped him both cope and accept that he would never be the same physically. Among the treatments he credits is an approach called EMDR — or eye movement desensitization and reprocessing. EMDR operates from the belief that sensory stimuli can help foster desensitization of traumatic memories. Spurts of focusing on disturbing images and memories are coupled with engaging in eye and hand exercises, or even exposure to specific tones. The bilateral attention is said to enable a realigning of the memories, and allow them to become disassociated from the trauma. The goal is to have them compartmentalized.

“It all sounds very hokey and new age, but it works,” says Anand Pandya, who is currently serving as the interim chair at Cedars-Sinai Hospital in Los Angeles. (Pandya is the co-founder of the Disaster Psychiatry Outreach organization. At the time of the attacks, Pandya was working as a forensic psychiatrist at the Bellevue Hospital Center in Manhattan, and regularly treated 9/11 survivors.)

EMDR is one of a variety of so-called exposure therapies aimed to provide relief for PTSD. These therapies have been the focus of the American medical community in the 9/11 decade, given that the attacks of that day were followed by two wars with high human tolls. For his part, Pandya advocates a therapy centering on muscle relaxation. Other forms of exposure therapy focus on deep-breathing.

It is theorized that among all first responders, police and firefighters were more adept at staving off long-term mental health problems because of their prior experience with similar trauma. But among other rescue workers, some 27.5 percent were experiencing depression, and 31.9 percent were dealing with PTSD by the ninth year after the attacks, according to The Lancet/Mount Sinai study.

“September 11 is interesting because the cleanup process took as long as it did,” Pandya says. “We know that the longer you are exposed, the more likely you are expected to develop a disorder.”

The disorders also have a hormonal component, Pandya adds. In a stressful event like arriving at the scene at Ground Zero, the body undergoes a hormonal transformation. It is theorized that the inclusion of cortisol, in a cascade of hormones that are released, can facilitate PTSD and the replaying of traumatic memories. And while the theory is still being looked at, it is now widely accepted that Selective Serotonin Reuptake Inhibitors (SSRIs) used to treat depression also help relieve PTSD.

“There’s a lot of overlap between physical and mental problems,” says Wisnivesky of Mount Sinai. To take one example, he says, the nearly half the rescue workers with asthma have at least one mental health condition.

Indeed, Silecchia, who worked in the shadow of the Ground Zero cross, developed cataracts as part of his physical breakdown. He relocated to South Carolina, and regularly attends therapy sessions.

“I am constantly plagued by this nightmare,” he says. “It’s about the sights and smells. That smell of death and decomposing bodies. I will never forget it.”

He says he’d like to attend events for the 10th year anniversary of the tragedy, but can’t afford the trip. Instead, he says, he passes his days working on cars and with tools like hammers and nails.

“I only get half the job done until the next day,” he says. “I’ll never get this out of my head.”

SB 923 would force the Administrative Director of the Division of Workers’ Compensation to adopt a fee schedule for physician services based on the Medicare RBRVS model at conversion factors that are so low, it would cause the best medical specialists to decline to treat injured workers. This has happened in every state that ever attempted to adopt a Medicare-based fee schedule at such low rates.

If workers are denied access to care from medical specialists such as general surgeons, orthopedic surgeons, internists, neurologists, rehabilitation physicians, anesthesiologists, radiologists, etc., and forced to obtain their treatment from general practitioners, it will delay their healing and return to productive, income-producing work.

If injured workers cannot obtain diagnostic tests and measurements such as EMGs, MRIs, echocardiograms, pulmonary function tests, and X-rays, they will not be able to prove the full extent of their impairment, thereby short-changing their permanent disability benefits. Employers will also suffer economic harm due to an inability to prove apportionment to non-industrial causes and for prolonged temporary disability benefits.

The ongoing maintenance of the Medicare Fee Schedule for California workers’ compensation will be very cumbersome, labor intensive, and expensive for employers who have to bear the cost of the frequent updates. California workers should not have their access to health care and rehabilitation dictated by the whims and vagaries of Washington politics.

Revenue neutral in California is 115% of Medicare. The sponsors of SB 923 cannot name one state that pays 125% of Medicare or less that doesn’t have a severe access to care problem for injured workers.